Surgeon deems Peavy's surgery a success

Nearly two years after White Sox pitcher Jake Peavy underwent experimental surgery to reattach a key tendon to the rear of his right shoulder, the performing surgeon said this week that the procedure can only be termed an unmitigated success.

"He had less than a 50 percent chance of returning to an elite level of pitching without the surgery," said Dr. Anthony Romeo, a professor and orthopedic surgeon at Chicago's Rush University Medical Center who devised the surgery. "It's my opinion that Jake's ability to pitch long term is no longer related to the latissimus tendon. In other words, it's a non-factor for him at this time."

Those are joyous words to Peavy's ears. The 30-year-old former National League Cy Young Award winner has finally returned to his old level of proficiency. Heading into Friday night's start against the Tigers at Comerica Park, he is 3-1 with a 1.67 ERA in five starts, the loss coming in a 1-0 complete-game effort.

Those numbers were good enough for him to be named American League Pitcher of the Month for April. On Thursday, Peavy called it simply a good start.

"It's certainly exciting to be back healthy and doing what I had done before getting here," he said. "That's something I feel blessed to be able to do. But at the same time, one month doesn't prove anything. It shows, hopefully, I'm healthy and can put together a few more [months] like this one and call it a good year."

Peavy won the Cy Young Award for the Padres in 2007 when he captured the NL's pitching Triple Crown with a 19-6 record, 2.54 ERA and 240 strikeouts. Subsequently, he was traded to the White Sox at the non-waiver Trade Deadline in 2009 and has been working to return to form since.

Trying to compensate for an ankle injury, Peavy completely ruptured the tendon that ties the latissimus dorsi muscle to the rear of the right shoulder. Less than a year later, on July 14, 2010, Romeo conducted the procedure that now should be called "Jake Peavy Surgery" to reattach the tendon to the bone. Dr. Romeo used a rare system of stitches and titanium anchors.

Peavy was the first Major League starting pitcher to undergo this procedure. He has now won 20 games since he was traded to the White Sox, 10 of them since the surgery.

A year ago, this was all new ground for orthopedic surgeons, and Dr. Romeo said then he had no way of knowing whether Peavy's shoulder would sustain the constant and repetitive nature of throwing 100 pitches every five days in a Major League game.

"That injury has been diagnosed in [starting] pitchers before, but it's never been treated with surgical repair," Romeo said at the time. "With Jake, we had the diagnosis right away. We knew what he had done and it was our opinion that the most likely way he'd be able to come back long-term without any restrictions was to do the surgery."

Since then, Peavy has made 23 starts. Romeo has the results and follow-up MRIs to show that Peavy's shoulder should no longer be an issue.

"It's been repaired. He's not had any problems with it," Romeo said this week. "There may be other issues in any decision for him to eventually stop throwing. Clearly, that looks like it's going to be some time from now the way he started out the season. But it's not going to be related to his latissimus tendon. That's healed. The muscle looks great and he's doing very well."

A recent article in The American Journal of Sports Medicine theorized that pitchers can return to action from this injury with varying results through non-operative therapy. The article analyzed 16 unnamed Major and Minor League pitchers, who have had strains and tears to the latissimus dorsi and opted not to take the Peavy route. The article also noted the only starting pitcher who has rebounded since having the surgery. That's Peavy.

"While it does appear that surgical repair of an latissimus dorsi tear in an elite-level pitcher can be successful, our data support non-operative management of strains as well as complete [tears] of the LD and teres major tendons with excellent results," the seven-page treatise concluded.

Romeo said that while that may be true of relief pitchers, it would be hard for him to imagine a starting pitcher like Peavy having made it back without the surgery.

"When you look at the diagnosis that Jake had, which was a complete avulsion or tearing, only 50 percent of the patients analyzed in the study were able to get back to pitching, and there was no clear evidence of what they were able to achieve," he said. "If it's just a strain to the muscle, you can treat that without surgery. But to get them back to their full potential, it would suggest that the surgical repair is the right way to go."

Romeo has been spot-on since the diagnosis. He originally told Peavy that it might be a year from the surgery before he'd be back on the mound. Peavy beat that benchmark by more than six months, but last year he suffered through bouts of shoulder tendinitis as he worked his way back. Romeo also warned him that the surgery came with some risks. Because the tendon had snapped from the bone, the effected muscle had furled more than five inches from the original attachment site.

"There are very important nerves that go to the lower arm and hand that if they were injured he would not have been able to grip or throw a baseball," Romeo said. "So doing the surgery, we had to be very, very careful."

High-density polyester synthetic stitches tied the tendon back to the bone using those anchors. Romeo described the stitches as akin to heavyweight fishing line and the anchors "like a molly bolt that is used for plaster, except that it has a little loop on the end of it."

The surgical technique had previously been performed on other athletes such as wrestlers and rock climbers. Like Tommy John, who paved the way for generations of pitchers to have ligament replacement elbow surgery that now bears his name, Peavy broke new ground.

Also like John, who went on to win 288 games in a 26-year career, so far, so good. Peavy's shoulder is holding together and he's back to pitching at an elite level.